SSQ Financial Group - Group Insurance: Forms

Home | Delegates | Contact us | Français

Critical Illness Insurance

Disability Insurance

Health Insurance

Employee Assistance Program

Diagnosis+

Dental Care Insurance

Expatriate Package

Mobile Services

Retiring or leaving a job

Diagnosis+

Health Capsules

Solareh - Posaction Plus

Solareh - Themaxis

Absenteeism Management

Rehabilitation

Additional Services

Forms

Here are some forms that may be useful in managing your group insurance plan.

Are you looking for other forms?
Ask our Customer Service department to give you a hand!

Health

Health Care Benefits

Health insurance claim (drugs, health care professionals, vision care expenses, etc.)

Foreign Nationals in Canada and Canadians Working Abroad

Health insurance claim for work abroad, whatever the nationality.

Prior Authorization - Exception Drugs or Limited Use Drugs

Prior authorization in the case of a claim for exception drugs or limited use drugs.

Request for brand name drug coverage

This form has to be completed by your physician to assess your request for coverage of a non-generic drug.

Dental care

Dental Care Benefits

Dental claim when you do not have access to the direct payment system. Note that a section of the form must be completed by your dentist.

Health Spending Account

Benefit claim with Health Spending Account

Claim for the portion of health and dental care insurance expenses which are not covered or exceed the coverage stipulated under your contract. You must already have a health spending account under your group insurance contract to use this form.

Wellness account

Benefit claim for your Wellness account

Claim for expenses related to wellness activities. A detailed list of amounts eligible can be found in your insurance booklet. You must already have a wellness account under your group insurance contract to use this form.

Accidental Death and Dismemberment (ADD)

Notice of Claim

Report a loss in the case of accidental death or dismemberment.

Accident

Proof of Loss in the Case of Accident

Proof of loss in the case of an accident.

Student Accident Insurance - Proof of Loss

Proof of loss when an accident occurs while participating in a school activity.

Sports Accident Insurance - Proof of Loss

Proof of loss when an accident occurs while participating in a sport.

Dental Claim - Proof of Loss in the Case of a Sports Accident

Proof of loss to be filled out by the attending dentist if dental care is required following an accident that occurred while participating in a sport.

Dental Claim - Claim in the Case of an Accident

Claim to be filled out by the attending dentist for dental care received following an accident.

Others

Authorization for Direct Debit Payments - Personal PAD

Authorization for the payment of your monthly insurance premium by preauthorized debit (SSQ Privilege).

Direct Deposit of your Health and Dental Care Insurance Benefits

Registration for direct deposit of your health and dental care insurance benefits.

Consent to Collect

Consent to collect and disclose personal information to a third party.

Proof of travel insurance coverage

Proof of travel insurance for the insured person who is covered under an individual or group insurance contract.